Pre-hospital trauma assessment is a set of skills used by emergency medical services

Emergency medical services

Emergency medical services are a type of emergency service dedicated to providing out-of-hospital acute medical care and/or transport to definitive care, to patients with illnesses and injuries which the patient, or the medical practitioner, believes constitutes a medical emergency...

 technicians to analyze all threats to life that a patient could suffer due to a trauma

Physical trauma

Trauma refers to "a body wound or shock produced by sudden physical injury, as from violence or accident." It can also be described as "a physical wound or injury, such as a fracture or blow." Major trauma can result in secondary complications such as circulatory shock, respiratory failure and death...

 incident. Pre-hospital trauma assessment is broken into two major types: basic trauma assessment and advanced trauma assessment. The basic assessment is provided by first responders and EMTs. The advanced assessment is provided by a paramedic

Paramedic

A paramedic is a healthcare professional that works in emergency medical situations. Paramedics provide advanced levels of care for medical emergencies and trauma. The majority of paramedics are based in the field in ambulances, emergency response vehicles, or in specialist mobile units such as...

.

1. Scene size-up
2. Initial assessment
3. Focused history and physical examination
   Physical examination
   Physical examination or clinical examination is the process by which a doctor investigates the body of a patient for signs of disease. It generally follows the taking of the medical history — an account of the symptoms as experienced by the patient...
   
   
4. Detailed physical examination
5. Ongoing assessment
6. Communications
7. Documentation

Scene size-up

Approaching and sizing up a trauma incident scene is one of the most important primary steps that a pre-hospital care provider carefully does. Within a critical trauma incident, seeing hazardous material and traffic in an uncontrolled environment is expected. These factors can cause life-threats for providers, coworkers, and bystanders. Therefore, controlling all these life-threats is initially accomplished even before patient contact.

After scene management, a pre-hospital care provider gets a general impression of the scene. A general impression is discovered by evaluating the mechanism of injury. For example, in a car accident, mechanism of injury is detected by estimating the speed at which the collision occurred, looking at the amount of damage, and looking for other factors that may affect the mechanism of injury, such as airbag

Airbag

An Airbag is a vehicle safety device. It is an occupant restraint consisting of a flexible envelope designed to inflate rapidly during an automobile collision, to prevent occupants from striking interior objects such as the steering wheel or a window...

 deployment.

This general impression helps the provider to make some important decisions regarding the number and type of transport units needed, and also helps to determine how critical a patient is.

Scene size-up consists of several steps which may be performed in different orders dependent upon circumstance:

• Body substance isolation
  Body substance isolation
  Body substance isolation is a practice of isolating all body substances of individuals undergoing medical treatment, particularly emergency medical treatment of those who might be infected with illnesses such as HIV, or hepatitis so as to reduce as much as possible the chances of transmitting...
  
   precautions
• Scene safety
• Mechanism of injury
• Number of patients and need for additional help
• Consider c-spine immobilization

Critical to the scene size-up is the need for quick decisions to be made. In the absence of hazards delaying progress, such decisions should be made by the time the patient is reached.

Initial assessment

The initial assessment for trauma patients does not differ from medical patient assessment. The primary outcome of the initial assessment is to determine any "immediate life threats".

The first step in performing an initial assessment is forming a general impression - is this patient "sick", "not sick", or "not sure". Taking steps to immobilize the patient's head to prevent any or any further injury to the spine

Spinal cord injury

A spinal cord injury refers to any injury to the spinal cord that is caused by trauma instead of disease. Depending on where the spinal cord and nerve roots are damaged, the symptoms can vary widely, from pain to paralysis to incontinence...

, the level of consciousness is assessed according to the AVPU criteria - Alert, responds to Verbal stimuli, responds to Pain stimuli, Unresponsive.

After checking the level of responsiveness, ABC is checked. ABC stands for airway, breathing, and circulation. In a trauma patient, sometimes the airway gets blocked due to facial injury or foreign body

Foreign body

A foreign body is any object originating outside the body. In machinery, it can mean any unwanted intruding object.Most references to foreign bodies involve propulsion through natural orifices into hollow organs....

 objects. According to Sanders, a patent airway should be maintained by positioning the patient properly, removing all blocking objects and carefully positioning the head using jaw-thrust technique.

The next step after maintaining a patent airway is checking breathing rate

Respiratory rate

Respiratory rate is also known by respiration rate, pulmonary ventilation rate, ventilation rate, or breathing frequency is the number of breaths taken within a set amount of time, typically 60 seconds....

 and quality. If the patient is breathing less than 8 times/minute or shallow more than 35/minutes, the patient then needs somebody to breathe for him using a [bag valve mask] attached to a high flow oxygen source.

Then, checking the pulse comes as the third step. For unresponsive adult patients, checking pulse is performed by palpating the carotid vein in the neck. For infants and small children, the pulse is usually assessed in the brachial artery

Brachial artery

The brachial artery is the major blood vessel of the arm.It is the continuation of the axillary artery beyond the lower margin of teres major muscle. It continues down the ventral surface of the arm until it reaches the cubital fossa at the elbow. It then divides into the radial and ulnar arteries...

 in the upper arm

Arm

In human anatomy, the arm is the part of the upper limb between the shoulder and the elbow joints. In other animals, the term arm can also be used for analogous structures, such as one of the paired forelimbs of a four-legged animal or the arms of cephalopods...

. After confirming that the pulse is present, the final step in the initial assessment for a trauma patient is to check for any gross bleeding and to control it. Should a pulse not be detected, or in the case of a child or infant is present but at a rate less than 60, cardiovascular resuscitation will be commenced.

Steps:

• General impression of the patient
• Assessing the patient's mental status
• Assessing the patient's airway status
• Assessing the patient's breathing status
• Assessing the patient's circulation
• Identifying priority patients

Focused history and physical examination

In a critical trauma incident, more than one provider is needed to be available to perform an assessment on one patient. After the initial assessment, one of the providers checks vital signs

Vital signs

Vital signs are measures of various physiological statistics, often taken by health professionals, in order to assess the most basic body functions. Vital signs are an essential part of a case presentation. The act of taking vital signs normally entails recording body temperature, pulse rate ,...

 and looks for any information about the patient's medical history

Medical history

The medical history or anamnesis of a patient is information gained by a physician by asking specific questions, either of the patient or of other people who know the person and can give suitable information , with the aim of obtaining information useful in formulating a diagnosis and providing...

. Other providers work on physically examining the patient to look for any life threats or other problems that can be fixed while en route to the hospital. A rapid head-to-toe exam is performed to look for any deformities, contusions, abrasions, punctures, burns, tenderness, swelling, and lacerations. If none of these are life-threats, they are ignored on scene and then begin immobilizing the patient on a long spine board

Long spine board

A spinal board, also known as a long spine board , longboard, spineboard, or backboard, is a patient handling device used primarily in pre-hospital trauma care designed to provide rigid support during movement of a patient with suspected spinal or limb injuries...

.

The initial assessment, primary survey, and immobilization of the patient do not take more than ten minutes to achieve.

Steps:

• Mechanism of injury
• Evaluating patients with serious injuries or mechanisms of injury
• Evaluating patients with no significant mechanisms of injury

Obtain Baseline Vital Signs
Obtain SAMPLE History

Ongoing assessment

The en route assessment starts when the patient is loaded in the ambulance. En route assessment begins with a repeat of the initial assessment and ensuring that the patient still has a patent airway, breathes or is being properly ventilated, and has a pulse.